METHODS: Retrospective case series of 20 children operated for severe tracheobronchomalacia at a tertiary hospital from 2003 to 2023. Data were collected on symptoms age at diagnosis, associated comorbidities, previous surgery, age at surgery, operative approach, time of follow-up, and outcome. Surgical success was defined as symptom improvement.
RESULTS: The most frequent symptoms of severe tracheobronchomalacia were stridor (50 %), cyanosis (50 %), and recurrent respiratory infections (45 %). All patients had one or more underlying conditions, most commonly esophageal atresia (40 %) and prematurity (35 %). Bronchoscopy were performed in all patients. Based on etiology, patients underwent the following procedures: anterior aortopexy (n = 15/75 %), posterior tracheopexy (n = 4/20 %), and/or posterior descending aortopexy (n = 4/20 %). Three patients underwent anterior aortopexy and posterior tracheopexy procedures. After a median follow-up of 12 months, 16 patients (80 %) had improvement in respiratory symptoms. Decannulation was achieved in three (37.5 %) out of eight patients with previous tracheotomy. The presence of dying spells at diagnosis was associated with surgical failure.
CONCLUSIONS: Isolated or combined surgical procedures improved respiratory symptoms in 80 % of children with severe tracheobronchomalacia. The choice of procedure should be individualized and guided by etiology: anterior aortopexy for anterior compression, posterior tracheopexy for membranous intrusion, and posterior descending aortopexy for left bronchus obstruction.
方法:回顾性病例系列,包括2003年至2023年在三级医院接受严重气管支气管软化手术的20名儿童。数据收集了诊断时的症状年龄,相关的合并症,以前的手术,手术年龄,手术入路,随访时间,和结果。手术成功被定义为症状改善。
结果:严重的气管支气管软化症最常见的症状是喘鸣(50%),紫癜(50%),和反复呼吸道感染(45%)。所有患者都有一种或多种潜在疾病,最常见的食管闭锁(40%)和早产(35%)。所有患者均行支气管镜检查。根据病因,患者接受了以下手术:前主动脉固定术(n=15/75%),后气管固定术(n=4/20%),和/或后降主动脉(n=4/20%)。三名患者接受了前主动脉固定术和后气管固定术。经过12个月的中位随访,16例(80%)患者呼吸道症状改善。在8例先前气管切开术的患者中,有3例(37.5%)实现了拔管。诊断时死亡咒语的存在与手术失败有关。
结论:在80%的严重气管支气管软化症患儿中,单独或联合外科手术可改善呼吸道症状。手术的选择应个体化,并以病因为指导:前主动脉固定术用于前压迫,后气管固定术用于膜质侵入,左支气管阻塞后降主动脉固定术。